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J Thorac Cardiovasc Surg 1998;116:370-371
© 1998 Mosby, Inc.

Letters To The Editor

The Batista procedure for dilated cardiomyopathy: An analysis that goes beyond "hand waving"

Jyotirmay Chanda, MD, PhD, Ryosei Kuribayashi, MD, PhD>

Reply to the Editor:

It is our great pleasure to address the points raised by Bridges in his letter regarding our recently published letter.Go 1 McCarthy and associatesGo 2 have clearly described the indication for the Batista procedure in patients with dilated cardiomyopathy. Bridges has quoted the opposite ("... reduction of ventricular mass leads to a reduction in calculated systolic stress") of what we intended to say in our letter: The basic principle of the Batista operation for dilated cardiomyopathy is not to reduce the mass of the ventricle but to reduce the volume of the chamber of the dilated ventricle, and thus to reduce the wall stress of the ventricle. This was our only criticism of the comment made by Dickstein, Spotnitz, and BurkhoffGo 3 in their article. This was evidenced in examplesGo 1 applying equation 7 cited in the text by Dickstein and colleagues.Go 3 Our thanks to Bridges for correcting the erroneous unit of the calculated wall stress (kdyne/cm2 instead of dyne/cm2), which was inadvertently overlooked. Although the judgment of "optimism" and "pessimism" goes beyond "hand waving," one should take into the account that the expected survival after transplantation would be only 5% over the subsequent year for patients waiting 6 months, which is the waiting time for many outpatients.Go 4

In our letterGo 1 we have discussed the importance of left ventricular mass/left ventricular end-systolic volume (LVM/LVESV) ratio and left ventricular mass/left ventricular end-diastolic volume (LVM/LVEDV) ratio on prognosis of survivals of patients with dilated cardiomyopathy. The survival was significantly higher for patients with an LVM/LVEDV ratio greater than 0.90 as compared with those with an LVM/LVEDV ratio less than 0.90.Go 5 The calculated value of mean LVM/LVESV ratio in survivors and nonsurvivors with dilated cardiomyopathyGo 6 was 1.36 and 1.06, respectively.Go 1 Similarly, in another report in patients with compensated dilated cardiomyopathy,Go 7 the calculated mean LVM/LVESV ratio (1.8) was higher than that (1.09) in patients with decompensated dilated cardiomyopathy.Go 1

On the basis of our present and previous discussion,Go Go Go 1,8,9 we speculate that patients with end-stage dilated cardiomyopathy with LVM/LVESV and LVM/LVEDV ratios less than 1.3 and 0.9, respectively, would be candidates for ventricular chamber volume reduction; intracavity patch-employed partial ventriculectomy and muscle-sparing chamber volume reduction would be the strategies when myocardial thickness is more (or equal to) and less than 10 mm, respectively.

, Bejpara, Sreedhar Tank Rd., Jessore 7400, BangladeshRyosei Kuribayashi, MD, PhD

Shonai Amarume Hospital, Yachita 41, Amarume, Higashi tagawa-gun, Yamagata 999-77, Japan

References

  1. Chanda J, Kuribayashi R, Abe T. Batista operation for dilated cardiomyopathy: a physiologic concept [letter]. J Thorac Cardiovasc Surg 1998;115:261-2.[Free Full Text]
  2. McCarthy PM, Starling RC, Wong J, et al. Early results with partial left ventriculectomy. J Thorac Cardiovasc Surg 1997;114:755-65.[Abstract/Free Full Text]
  3. Dickstein ML, Spotnitz HM, Burkhoff D. Heart reduction surgery: an analysis of the impact on cardiac function. J Thorac Cardiovasc Surg 1997;113:1032-40.[Abstract/Free Full Text]
  4. Stevenson LW, Hamilton MA, Tillisch IH, et al. Decreasing survival benefit from cardiac transplantation for outpatients as the waiting list lengthens. J Am Coll Cardiol 1991;18:919-25.[Abstract]
  5. Field BJ, Baxley WA, Russell RO Jr, et al. Left ventricular function and hypertrophy in cardiomyopathy with depressed ejection fraction. Circulation 1973;47:1022-31.[Abstract/Free Full Text]
  6. Douglas PS, Morrow R, Ioli A, Reichek N. Left ventricular shape, afterload and survival in idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1989;13:311-5.[Abstract]
  7. Hirota Y, Shimizu G, Kaku K, Saito T, Kino M, Kawamura K. Hypertrophic nonobstructive cardiomyopathy: a precise assessment of hemodynamic characteristics and clinical implications. Am J Cardiol 1984;54:1033-8.[Medline]
  8. Chanda J, Kuribayashi R, Abe T. Ventricular remodelling in dilated cardiomyopathy [letter]. Lancet 1997;350:1705-6.[Medline]
  9. Chanda J, Kuribayashi R. Should the surgical technique of the left ventricular volume reduction be modified [letter]? J Thorac Cardiovasc Surg. In press.




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